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  • Hypertension Illustrated
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Orthostatic hypotension and Holmes-Adie syndrome. Usefulness of the Valsalva ratio in the evaluation of baroreceptor dysfunction

Journal of Human Hypertension volume 16, pages 661–662 (2002)Cite this article

This report is one in the series ‘Hypertension Illustrated’ and presents a case of Holmes-Adie syndrome with orthostatic hypotension and autonomic dysfunction. This clinical syndrome is characterised by unilateral or bilateral tonic pupils with near-light dissociation and tendon areflexia1,2,3 and is associated with disturbances in autonomic function in 28 to 40% of patients4,5,6 and more seldomly with paroxysmal coughing.7 In the present report, we emphasise the usefulness of and describe how the Valsalva ratio can be used to investigate baroreceptor dysfunction.

The absence of heart rate response to orthostatic hypotension, to the Valsalva manoeuver and to the blood pressure increase during pressor infusion all suggest a failure of the afferent baroreflex nerve fibres. Conversely, the presence of a blood pressure response to the cold pressor test and to clonidine administration suggests that the efferent autonomic pathways are functioning adequately.

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Authors and Affiliations

  1. Division of Nephrology, and Department of Medicine, CHUQ, L'Hôtel-Dieu de Québec Hospital, Laval University, Quebec City, G1R 2J6, Canada

    D Émond & M Lebel

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  1. D Émond
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  2. M Lebel
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Correspondence to M Lebel.

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Émond, D., Lebel, M. Orthostatic hypotension and Holmes-Adie syndrome. Usefulness of the Valsalva ratio in the evaluation of baroreceptor dysfunction. J Hum Hypertens 16, 661–662 (2002). https://doi.org/10.1038/sj.jhh.1001455

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  • DOI: https://doi.org/10.1038/sj.jhh.1001455

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